Eczema

Question 1

What is eczema?

Answer 1

A group of skin conditions that cause inflammation/ irritation of the skin - itchy

also known as dermatitis

Question 2

Clinical features of eczema?

Answer 2

Erythema
Itch
Scaling
Dryness

Acute

• pain
• bleeding
• weeping
• vesicles/blisters

Chronic

• fissures
• lichenification

Question 3

Types of eczema

Answer 3

• atopic
• discoid
• seborrhoeic
• venous/varicose/stasis/gravitational
• asteatotic
• pompholytic
• irritant contact
• allergic contact

Question 4

Common places for eczema?

Answer 4

flexures

e.g. elbows, behind knees

Question 5

Epidemiology of atopic eczema

Answer 5

• prevalence in children around 10-20%
• onset usually under 2y
• 50% grow out by 2y
• 80% grow out by adolescence
• asthma, hayfever, eczema - atopy

Question 6

Aetiology of atopic eczema?

Answer 6

genetic and environmental

cause unclear lol

Question 7

What is atopic eczema exacerbated by?

Answer 7

• irritants e.g. soap, nylon clothing
• illness/ teething
• skin infection
• stress
• change in weather
• allergy

Question 8

What age group normally gets seborrhoeic eczema?

Answer 8

Young-middle aged adults

Question 9

Which organism is seborrhoeic eczema associated with?

Answer 9

Pityrosporum spp

Question 10

What is seborrhoeic eczema exacerbated by?

Answer 10

alcohol

Question 11

Treatment of seborrhoeic eczema?

Answer 11

• emollients
• topical antifungals
• mildly potent topical steroidsl

Question 12

What might discoid eczema be a manifestation of?

Answer 12

atopic eczema

Question 13

What is varicose eczema a sign of?

Answer 13

chronic venous disease

Question 14

Why is compression helpful in varicose eczema

Answer 14

To prevent recurrence

Question 15

What is irritant contact dermatitis?

Answer 15

Direct effect of irritant substances destroying epidermis

Question 16

Most common site of irritant contact dermatitis?

Answer 16

Dorsum of hands and finger webbs

Question 17

Irritant contact dermatitis is common in which occupations?

Answer 17

hairdressers
chefs
housewives
cleaners
nurses

Question 18

What is allergic contact dermatitis?

Answer 18

Eczema following a type 4 delayed cell mediated allergic reaction to contact with a substance

Question 19

Common sources causing allergic contact dermatitis?

Answer 19

• nickel in jewellery and buckles
• hair dye
• plants
• topical medications
• fragrance
• occupational

Question 20

How is allergic contact dermatitis diagnosed?

Answer 20

Patch testing
- series of substances placed on metal plate on patient’s back for 48h and skin is measured at 48h and 72h for a reaction

Question 21

Management of eczema?

Answer 21

• Avoid exacerbating factors
• Treat dry skin with emollient
• Treat active eczema with topical steroids
• Consider 2nd line treatments if ineffective or side effects

Question 22

Example of mild steroid?

Answer 22

Hydrocortisone 1%

• face
• children

Question 23

Example of a moderate steroid?

Answer 23

Eumovate (clobetosome)

• face and body
• children and adults

Question 24

Example of a potent steroid?

Answer 24

Betnovate, Elocon

• do not use on face/ special sites
• adults

Question 25

Example of a very potent steroid?

Answer 25

Dermovate (clobetosol)

• adults
• palms and soles
• hand dermatitis

Question 26

Side effects of steroids?

Answer 26

• striae
• skin atrophy
• telangectasia
• perioral dermatitis
• ## glaucoma and catarracts

Question 27

Which is better ointment or cream and why?

Answer 27

OINTMENT 
- greater efficacy
- emollient effect
- less likely to develop allergy
but greasy and FLAMMABLE

Question 28

second line treatments for eczema?

Answer 28

• topical immunomodulators
• bandaging/ wet wraps
• systemic treatments (UV light, oral prednisolone, cyclosporin, azathioprine)